Search results for: long-term care cost

Authors: Justin Lee, Siraj Shaikh, Alice Chu MD

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Children with cerebral palsy (CP) commonly present with upper extremity impairment, affecting one or both extremities, and are classified using the Manual Ability Classification Scale (MACS). The MACS defines bimanual hand abilities for children ages 4-18 years in everyday tasks and is a gradient scale, with I being nearly normal and V requiring total assistance. Children with more severe upper extremity impairment (MACS III-V) are often underrepresented, and relatively few effective therapies have been identified for these patients. Current orthoses are static and are only meant to prevent the progression of contractures in these patients. Other limitations include cost, comfort, accessibility, and longevity of the orthoses. Taking advantage of advances in 3D printing technology, we have created a highly customizable upper extremity orthotic that can be produced at a low cost. Iterations in our design have resulted in an orthotic that is custom fit to the patient based on scans of their arm, made of rigid polymer when needed to provide support, flexible material where appropriate to allow for comfort, and designed with a mechanical pulley system to allow for some functional use of the arm while in the orthotic. Preliminary data has shown that our orthotic can be built at a fraction of the cost of current orthoses and provide clinically significant improvement in assisting hand assessment (AHA) and pediatric quality of life scores (PedsQL).

Keywords: upper extremity orthosis, upper extremity, orthosis, 3-D printing, cerebral palsy, occupational therapy, spasticity, customizable

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Authors: Susanta Kumar Gachhayat, S. K. Dash

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Multi objective non-convex economic dispatch problems of a thermal power plant are of grave concern for deciding the cost of generation and reduction of emission level for diminishing the global warming level for improving green-house effect. This paper deals with ramp rate constraints for achieving better inequality constraints so as to incorporate valve point loading for cost of generation in thermal power plant through ramp rate biogeography based optimization involving mutation and migration. Through 50 out of 100 trials, the cost function and emission objective function were found to have outperformed other classical methods such as lambda iteration method, quadratic programming method and many heuristic methods like particle swarm optimization method, weight improved particle swarm optimization method, constriction factor based particle swarm optimization method, moderate random particle swarm optimization method etc. Ramp rate biogeography based optimization applications prove quite advantageous in solving non convex multi objective economic dispatch problems subjected to nonlinear loads that pollute the source giving rise to third harmonic distortions and other such disturbances.

Keywords: economic load dispatch, ELD, biogeography-based optimization, BBO, ramp rate biogeography-based optimization, RRBBO, valve-point loading, VPL

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Authors: Evelyn Castle, Adam Thompson

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Background: In 2013, the Kano State Primary Health Care Management Board redesigned its Routine immunization supply chain from diffused pull to direct delivery push. It addressed issues around stockouts and reduced time spent by health facility staff collecting, and reporting on vaccine usage. The health care board sought the help of a 3PL for twice-monthly deliveries from its cold store to 484 facilities across 44 local governments. eHA’s Health Delivery Systems group formed a 3PL to serve 326 of these new facilities in partnership with the State. We focused on designing and implementing a technology system throughout. Basic methodologies: GIS Mapping: - Planning the delivery of vaccines to hundreds of health facilities requires detailed route planning for delivery vehicles. Mapping the road networks across Kano and Bauchi with a custom routing tool provided information for the optimization of deliveries. Reducing the number of kilometers driven each round by 20%, - reducing cost and delivery time. Direct Delivery Information System: - Vaccine Direct Deliveries are facilitated through pre-round planning (driven by health facility database, extensive GIS, and inventory workflow rules), manager and driver control panel customizing delivery routines and reporting, progress dashboard, schedules/routes, packing lists, delivery reports, and driver data collection applications. Move: Last Mile Logistics Management System: - MOVE has improved vaccine supply information management to be timely, accurate and actionable. Provides stock management workflow support, alerts management for cold chain exceptions/stock outs, and on-device analytics for health and supply chain staff. Software was built to be offline-first with user-validated interface and experience. Deployed to hundreds of vaccine storage site the improved information tools helps facilitate the process of system redesign and change management. Findings: - Stock-outs reduced from 90% to 33% - Redesigned current health systems and managing vaccine supply for 68% of Kano’s wards. - Near real time reporting and data availability to track stock. - Paperwork burdens of health staff have been dramatically reduced. - Medicine available when the community needs it. - Consistent vaccination dates for children under one to prevent polio, yellow fever, tetanus. - Higher immunization rates = Lower infection rates. - Hundreds of millions of Naira worth of vaccines successfully transported. - Fortnightly service to 326 facilities in 326 wards across 30 Local Government areas. - 6,031 cumulative deliveries. - Over 3.44 million doses transported. - Minimum travel distance covered in a round of delivery is 2000 kms & maximum of 6297 kms. - 153,409 kms travelled by 6 drivers. - 500 facilities in 326 wards. - Data captured and synchronized for the first time. - Data driven decision making now possible. Conclusion: eHA’s Vaccine Direct delivery has met challenges in Kano and Bauchi State and provided a reliable delivery service of vaccinations that ensure t health facilities can run vaccination clinics for children under one. eHA uses innovative technology that delivers vaccines from Northern Nigerian zonal stores straight to healthcare facilities. Helped healthcare workers spend less time managing supplies and more time delivering care, and will be rolled out nationally across Nigeria.

Keywords: direct delivery information system, health delivery system, GIS mapping, Northern Nigeria, vaccines

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Authors: Recep Keşli, Gülşah Aşık, Cengiz Demir, Onur Türkyılmaz

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Objective: Proteus mirabilis (P. mirabilis) is one of Gram-negative pathogens in human and it causes urinary tract and nosocomial infections. P. mirabilis is susceptible to β-lactams, aminoglycosides, fluoroquinolones, and trimethoprim/sulfamethoxazole. It was aimed to investigate the resistance status to antimicrobial agents of Proteus mirabilis strains produced from samples sent to Afyon Kocatepe University, ANS Research and Practice Hospital, Microbiology Laboratory from different clinics and polyclinics during the period of 24 months. Methods: Between October 2013 and September 2015, a total of 30 Proteus were isolated from clinical samples of patients were hospitalized in intensive care units and in various departments of Afyon Kocatepe University, ANS Research and Practice Hospital. Identification of the bacteria was determined by conventional methods and VITEK 2 system (bioMérieux, France) was used additionally. Antibacterial susceptibility tests were performed by Kirby Bauer disc (Oxoid, Hempshire, England) diffusion method following the recommendations of CLSI. Results: Of the total 30 Proteus strains isolated from clinical samples, 19 from urine, 7 from wound, 4 from tracheal aspiration materials were isolated. Antimicrobial resistant for these strains were determined to 24,3% for meropenem, 26.2% for imipenem, 20.2% for amikacin 10.5% for cefepim, 33.3% for ciprofloxacin and levofloxacine, 31.6% for ceftazidime, 20% for ceftriaxone, 15.2% for gentamicin and 26.6% for amoxicillin-clavulanate, 26.2% trimethoprim-sulfamethoxale. Conclusion: In the present study, the highest number of clinical isolates of P. mirabilis were isolated from urine (63,3%), followed by the others (36,6%). The distribution of samples P. mirabilis strains to the clinics were as fallows; 16,8% intensive care unit (ICU), 29,9% polyclinics, 53,3% hospital service units The most effective antibiotic on the total of strains were found to be cefepim, the least effective antibiotics on the total of strains were found to be trimethoprim-sulfamethoxale.

Keywords: proteus mirabilis, antibiotic resistance, intensive care unit, Proteus spp.

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Authors: Babitha Elizabeth Philip

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This paper aims to study in general about bridges without expansion joints. Integral Abutment Bridges (IAB) fall into this category of bridges. They are having a continuous deck and also the girders are integrated into the abutments. They are most cost effective system in terms of construction, maintenance, and longevity. The main advantage of IAB is that it is corrosion resistant since water is not allowed to pass through the structure. The other attractions of integral bridges are its simple and rapid construction, smooth and uninterrupted deck which provides a safe ride. Also damages to the abutments can be avoided to a great extent due to better load distribution at the bridge ends. Damages due to improper drainage are not seen in IAB because of its properly drained approach slabs thus eliminating the possibility of erosion of the abutment backfill and freeze and thaw damage resulting from saturated backfill.

Keywords: continuous bridge, integral abutment bridge, joint bridge, life cycle cost, soil interaction

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Authors: Anshar Ajatasatru

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The decline of coal prices over past years have been significantly increasing the awareness of effective mining operation. A viable step must be undertaken in becoming more cost competitive while striving for best mining practice especially at Melak Coal Mine in East Kalimantan, Indonesia. This paper aims to show how effective dozer push measurement method can be implemented as it is controlled by contract rate on the unit basis of USD ($) per bcm. The method emerges from an idea of daily dozer push activity that continually shifts the overburden until final target design by mine planning. Volume calculation is then performed by calculating volume of each time overburden is removed within determined distance using cut and fill method from a high precision GNSS system which is applied into dozer as a guidance to ensure the optimum result of overburden removal. Accumulation of daily to weekly dozer push volume is found 95 bcm which is multiplied by average sell rate of $ 0,95, thus the amount monthly revenue is $ 90,25. Furthermore, the payment mechanism is then based on push distance and push grade. The push distance interval will determine the rates that vary from $ 0,9 - $ 2,69 per bcm and are influenced by certain push slope grade from -25% until +25%. The amount payable rates for dozer push operation shall be specifically following currency adjustment and is to be added to the monthly overburden volume claim, therefore, the sell rate of overburden volume per bcm may fluctuate depends on the real time exchange rate of Jakarta Interbank Spot Dollar Rate (JISDOR). The result indicates that dozer push measurement can be one of the surface mining alternative since it has enabled to refine method of work, operating cost and productivity improvement apart from exposing risk of low rented equipment performance. In addition, payment mechanism of contract rate by dozer push operation scheduling will ultimately deliver clients by almost 45% cost reduction in the form of low and consistent cost.

Keywords: contract rate, cut-fill method, dozer push, overburden volume

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Authors: Andrew Anis Fakhrey Mosaad

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Introduction: Sports- and physical activity-related injuries may be more likely if there is a genetic predisposition, improper coaching and/or training, and no follow-up care from sports medicine. Goal: To evaluate the frequency of injuries among athletes receiving care at a sportsfocused physical therapy clinic. Methods: The survey of injuries in athletes' treatment records over a period of eight years of activity was done to obtain data. The data collected included: the patient's features, the sport, the type of injury, the injury's characteristics, and the body portion injured. Results: The athletes were drawn from 1090 patient/athlete records, had an average age of 25, participated in 44 different sports, and were 75% men on average. Joint injuries were the most frequent type of injury, then damage to the muscles and bones. The most prevalent type of injury was chronic (47%), while the knee, ankle, and shoulder were the most frequently damaged body parts. The most injured athletes were seen in soccer, futsal, and track and field, respectively, out of all the sports. Conclusion: The most popular sport among injured players was soccer, and the most common injury type was joint damage, with the knee being the most often damaged body area. The majority of the injuries were chronic.

Keywords: sports injuries, athletes, joint injuries, injured players

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Authors: Stavroula Stavropoulou-Tatla, Danyal Awal, Mohammad Ayaz Hossain

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The first wave of the COVID-19 pandemic saw several countries issue guidance postponing all non-urgent diagnostic evaluations and operations, leading to an estimated backlog of 28 million cases worldwide and over 4 million in the UK alone. In an attempt to regulate the resumption of elective surgical activity, the National Institute for Health and Care Excellence (NICE) introduced the ‘COVID-19 rapid guideline [NG179]’. This project aimed to increase healthcare staff knowledge of the aforementioned guideline to a targeted score of 100% in the disseminated questionnaire within 3 months at the Royal Free Hospital. A standardized online questionnaire was used to assess the knowledge of surgical and medical staff at baseline and following each 4-week-long Plan-Study-Do-Act (PDSA) cycle. During PDSA1, the A4 visual summary accompanying the guideline was visibly placed in all relevant clinical areas and the full guideline was distributed to the staff in charge together with a short briefing on the salient points. PDSA2 involved brief small-group teaching sessions. A total of 218 responses was collected. Mean percentage scores increased significantly from 51±19% at baseline to 81±16% after PDSA1 (t=10.32, p<0.0001) and further to 93±8% after PDSA2 (t=4.9, p<0.0001), with 54% of participants achieving a perfect score. In conclusion, the targeted distribution of guideline printouts and visual aids, combined with small-group teaching sessions, were simple and effective ways of educating healthcare staff about the new standards of elective surgical care at the time of COVID-19. This could facilitate the safe restoration of surgical activity, which is critical in order to mitigate the far-reaching consequences of surgical delays on an unprecedented scale during a time of great crisis and uncertainty.

Keywords: COVID-19, elective surgery, NICE guidelines, quality improvement

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Authors: Adedayo Jeremiah Adeyekun, Samuel Oluwagbemiga Ishola,

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This paper is an assessment of factors influencing the cost and time performance of subcontractors and the need for effective performance of subcontractors at the project sites. The factors influencing the performance of subcontractors are grouped, similar to those identified with the project or an organization and on another hand, there are significant factors influencing the performance of the subcontractors. These factors incorporate management level leadership, time required to complete the project, profit, staff capability/expertise, reputation, installment method, organization history, and project procurement method strategy, security, bidding technique, insurance, bond and relationship with the major contractors. The factors influencing the management of subcontractors in building development projects includes performance of significant past projects, standard of workmanship, consistence with guidelines, regular payment to labourers, adherence to program, regularity and viability of communication with main contractor, adherence to subcontract necessities. Other factors comprise adherence to statutory environmental regulations, number of experienced sites administrative staff, inspection and maintenance of good workplace, number of artisans and workers, quality of as-built and shop drawings and ability to carry out the quantity of work and so on. This study also aimed to suggest a way forward to improve the performance of subcontractors which is the reason for exceeding budget at the project sites. To carry out this study, a questionnaire was drafted to derive information on the causes of low performance of subcontractors and the implication to cost.

Keywords: performance, contractor, subcontractors, construction

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Authors: Lateefat Amao, Misagh Faezipour

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Implementing electronic health records (EHR) in healthcare is a pivotal transition aimed at digitizing and optimizing patient health information management. The expectations associated with this transition are high, even towards other health information systems (HIS) and health technology. This multifaceted process involves careful planning and execution to improve the quality and efficiency of patient care, especially as healthcare technology is a sensitive niche. Key considerations include a thorough needs assessment, judicious vendor selection, robust infrastructure development, and training and adaptation of healthcare professionals. Comprehensive training programs, data migration from legacy systems and models, interoperability, as well as security and regulatory compliance are imperative for healthcare staff to navigate EHR systems adeptly. The purpose of this work is to offer a comprehensive review of the literature on EHR implementation. It explores the impact of this health technology on health practices, highlights challenges and barriers to its successful utility, and offers practical strategies that can impact its success in healthcare. This paper provides a thorough review of studies on the adoption of EHRs, emphasizing the wide range of experiences and results connected to EHR use in the medical field, especially across different types of healthcare organizations.

Keywords: healthcare, electronic health records, EHR implementation, patient care, interoperability

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Authors: Faeze omid, Morteza Banakar

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Background: The COVID-19 pandemic has had a significant impact on global health and healthcare systems, including oral health. The lockdown measures implemented in many countries have led to changes in oral health behaviors, access to dental care, and the delivery of dental services. However, the extent of these changes and their effects on oral health outcomes remains unclear. This systematic review aims to synthesize the available evidence on the state of oral health after the COVID-19 lockdown. Methods: We conducted a systematic search of electronic databases (PubMed, Embase, Scopus, and Web of Science) and grey literature sources for studies reporting on oral health outcomes after the COVID-19 lockdown. We included studies published in English between January 2020 and March 2023. Two reviewers independently screened the titles, abstracts, and full texts of potentially relevant articles and extracted data from included studies. We used a narrative synthesis approach to summarize the findings. Results: Our search identified 23 studies from 12 countries, including cross-sectional surveys, cohort studies, and case reports. The studies reported on changes in oral health behaviors, access to dental care, and the prevalence and severity of dental conditions after the COVID-19 lockdown. Overall, the evidence suggests that the lockdown measures had a negative impact on oral health outcomes, particularly among vulnerable populations. There were decreases in dental attendance, increases in dental anxiety and fear, and changes in oral hygiene practices. Furthermore, there were increases in the incidence and severity of dental conditions, such as dental caries and periodontal disease, and delays in the diagnosis and treatment of oral cancers. Conclusion: The COVID-19 pandemic and associated lockdown measures have had significant effects on oral health outcomes, with negative impacts on oral health behaviors, access to care, and the prevalence and severity of dental conditions. These findings highlight the need for continued monitoring and interventions to address the long-term effects of the pandemic on oral health.

Keywords: COVID-19, oral health, systematic review, dental public health

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Authors: Silvia D. Vaca, Benjamin J. Kuo, Joao Ricardo Nickenig Vissoci, Catherine A. Staton, Linda W. Xu, Michael Muhumuza, Hussein Ssenyonjo, John Mukasa, Joel Kiryabwire, Henry E. Rice, Gerald A. Grant, Michael M. Haglund

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Background: Patients with traumatic brain injury (TBI) can develop rapid neurological deterioration from swelling and intracranial hematomas, which can result in focal tissue ischemia, brain compression, and herniation. Moreover, delays in management increase the risk of secondary brain injury from hypoxemia and hypotension. Therefore, in TBI patients with subdural hematomas (SDHs) and epidural hematomas (EDHs), surgical intervention is both necessary and time sensitive. Significant delays are seen along the care continuum in low- and middle-income countries (LMICs) largely due to limited healthcare capacity to address the disproportional rates of TBI in Sub Saharan Africa (SSA). While many LMICs have subsidized systems to offset surgical costs, the burden of securing funds by the patients for medications, supplies, and CT diagnostics poses a significant challenge to timely surgical interventions. In Kampala Uganda, the challenge of obtaining timely CT scans is twofold: logistical and financial barriers. These bottlenecks contribute significantly to the care continuum delays and are associated with poor TBI outcomes. Objective: The objectives of this study are to 1) describe the temporal delays through a modified three delays model that fits the context of neurosurgical interventions for TBI patients in Kampala and 2) investigate the association between delays and mortality. Methods: Prospective data were collected for 563 TBI patients presenting to a tertiary hospital in Kampala from 1 June – 30 November 2016. Four time intervals were constructed along five time points: injury, hospital arrival, neurosurgical evaluation, CT results, and definitive surgery. Time interval differences among mild, moderate and severe TBI and their association with mortality were analyzed. Results: The mortality rate of all TBI patients presenting to MNRH was 9.6%, which ranged from 4.7% for mild and moderate TBI patients receiving surgery to 81.8% for severe TBI patients who failed to receive surgery. The duration from injury to surgery varied considerably across TBI severity with the largest gap seen between mild TBI (174 hours) and severe TBI (69 hours) patients. Further analysis revealed care continuum differences for interval 3 (neurosurgical evaluation to CT result) and 4 (CT result to surgery) between severe TBI patients (7 hours for interval 3 and 24 hours for interval 4) and mild TBI patients (19 hours for interval 3, and 96 hours for interval 4). These post-arrival delays were associated with mortality for mild (p=0.05) and moderate TBI (p=0.03) patients. Conclusions: To our knowledge, this is the first analysis using a modified 'three delays' framework to analyze the care continuum of TBI patients in Uganda from injury to surgery. We found significant associations between delays and mortality for mild and moderate TBI patients. As it currently stands, poorer outcomes were observed for these mild and moderate TBI patients who were managed non-operatively or failed to receive surgery while surgical services were shunted to more severely ill patients. While well intentioned, high mortality rates were still observed for the severe TBI patients managed surgically. These results suggest the need for future research to optimize triage practices, understand delay contributors, and improve pre-hospital logistical referral systems.

Keywords: care continuum, global neurosurgery, Kampala Uganda, LMIC, Mulago, traumatic brain injury

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Authors: Sayna Bahraini, Wendy Gifford, Ian Graham, Liquaa Wazni, Suzettee Bremault-Phillips, Rebekah Hackbusch, Catrine Demers, Mary Egan

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Objective: Guidelines for palliative and spiritual care emphasize the importance of screening patients for spiritual suffering. The aim of this review was to synthesize the research evidence on the accuracy of measures used to screen adults for spiritual suffering. Methods: A systematic review has been conducted. We searched five scientific databases to identify relevant articles. Two independent reviewers screened extracted data and assessed study methodological quality. Results: We identified five articles that yielded information on 24 spiritual screening measures. Among all identified measures, the 2-item Meaning/Joy & Self-Described Struggle has the highest sensitivity (82-87%), and the revised Rush protocol has the highest specificity (81-90%). The methodological quality of all included studies was low. Significance of Results: While most of the identified spiritual screening measures are brief (comprise 1 to 12 number of items), few have sufficient accuracy to effectively screen patients for spiritual suffering. We advise clinicians to use their critical appraisal skills and clinical judgment when selecting and using any of the identified measures to screen for spiritual suffering.

Keywords: screening, suffering, spirituality, diagnostic test accuracy, systematic review

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Authors: Stephen Rulisa, Aimee Nyiramahirwe

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Background: Strategies to increase the uptake of contraception services have been adopted in Rwanda, but the unmet need for family planning remains high. Women in the postpartum period are at higher risk for unintended pregnancy due to the silent conversion from lactational amenorrhea to reactivation of ovulatory cycles. The purpose of this study was to explore the role of male partners in the uptake of postpartum contraception. Methods: A prospective cross-sectional study was conducted among women who delivered at the University Teaching Hospital of Kigali for a period of 3 months with random sampling. A questionnaire was used to collect socio-demographic and antenatal data, information on male companionship, and intent to use postpartum contraception at admission. Participants were contacted six weeks later to collect data on contraceptive use. The outcome variables were uptake of postpartum contraception and types of contraceptives taken (long-acting vs. short-acting), controlling for male companionship during the antenatal period. A Chi-square test was used and a p-value ≤0.05 was considered significant. Results: A total of 209 women were recruited with a mean age of 30.8±5.2 years. The majority (60.9%) were multigravida, and 66.5% were multiparous. More than half (55%) had male partner companionship, 18.3% had companionship for four antenatal visits, and 28.2% had education on contraception with their male partner. Factors significantly associated with uptake of postpartum contraception were: age above 30 years, owning or heading a business, multigravidity, multiparity, antenatal care at a health center or district hospital, cesarean delivery, and previous utilization of contraception. Male companionship significantly increased the intent to use contraception, uptake of modern contraception in general, and uptake of long active contraceptives but did not predict the uptake of short-acting contraceptives. Conclusions: Our study demonstrates a positive association between male companionship during antenatal care, labor and delivery with the uptake of postpartum family planning. Our study suggests more sensitization to involve the male partners, improving the education on contraception during antenatal care and further research to assess the sustained uptake of contraception beyond the postpartum period.

Keywords: postpartum, family planning, contraception, male partner, uptake

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Authors: Yekini N. Asafe, Haastrup A. Victor, Lawal N. Olawale, Okikiola F. Mercy

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Recent increase in access to personal computer and networking systems have made it feasible to perform much of cumbersome and costly paper-based administration in all organization. Desktop computers, networking systems, high capacity storage devices and telecommunications system is currently allowing the transfer of various format of data to be processed, stored and dissemination for the purpose of decision making. Going paperless is more of benefits compare to full paper-based office. This paper proposed a model for design and implementation of e-administration system (paperless campus) for an institution of learning. If this model is design and implemented it will reduced cost and complexity of educational administration also eliminate menaces and environmental hazards attributed to paper-based administration within schools and colleges.

Keywords: e-administration, educational administration, paperless campus, paper-based administration

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Authors: Niya Chen, Jennifer Chan

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In the financial market, risk management helps to minimize potential loss and maximize profit. There are two ways to assess risks; the first way is to calculate the risk directly based on the volatility. The most common risk measurements are Value at Risk (VaR), sharp ratio, and beta. Alternatively, we could look at the quantile of the return to assess the risk. Popular return models such as GARCH and stochastic volatility (SV) focus on modeling the mean of the return distribution via capturing the volatility dynamics; however, the quantile/expectile method will give us an idea of the distribution with the extreme return value. It will allow us to forecast VaR using return which is direct information. The advantage of using these non-parametric methods is that it is not bounded by the distribution assumptions from the parametric method. But the difference between them is that expectile uses a second-order loss function while quantile regression uses a first-order loss function. We consider several quantile functions, different volatility measures, and estimates from some volatility models. To estimate the expectile of the model, we use Realized Conditional Autoregressive Expectile (CARE) model with the bayesian method to achieve this. We would like to see if our proposed models outperform existing models in cryptocurrency, and we will test it by using Bitcoin mainly as well as Ethereum.

Keywords: expectile, CARE Model, CARR Model, quantile, cryptocurrency, Value at Risk

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Authors: O. Adjoul, A. Feugier, K. Benfriha, A. Aoussat

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In general, issues related to design and maintenance are considered in an independent manner. However, the decisions made in these two sets influence each other. The design for maintenance is considered an opportunity to optimize the life cycle cost of a product, particularly in the nuclear or aeronautical field, where maintenance expenses represent more than 60% of life cycle costs. The design of large-scale systems starts with product architecture, a choice of components in terms of cost, reliability, weight and other attributes, corresponding to the specifications. On the other hand, the design must take into account maintenance by improving, in particular, real-time monitoring of equipment through the integration of new technologies such as connected sensors and intelligent actuators. We noticed that different approaches used in the Design For Maintenance (DFM) methods are limited to the simultaneous characterization of the reliability and maintainability of a multi-component system. This article proposes a method of DFM that assists designers to propose dynamic maintenance for multi-component industrial systems. The term "dynamic" refers to the ability to integrate available monitoring data to adapt the maintenance decision in real time. The goal is to maximize the availability of the system at a given life cycle cost. This paper presents an approach for simultaneous optimization of the design and maintenance of multi-component systems. Here the design is characterized by four decision variables for each component (reliability level, maintainability level, redundancy level, and level of monitoring data). The maintenance is characterized by two decision variables (the dates of the maintenance stops and the maintenance operations to be performed on the system during these stops). The DFM model helps the designers choose technical solutions for the large-scale industrial products. Large-scale refers to the complex multi-component industrial systems and long life-cycle, such as trains, aircraft, etc. The method is based on a two-level hybrid algorithm for simultaneous optimization of design and maintenance, using genetic algorithms. The first level is to select a design solution for a given system that considers the life cycle cost and the reliability. The second level consists of determining a dynamic and optimal maintenance plan to be deployed for a design solution. This level is based on the Maintenance Free Operating Period (MFOP) concept, which takes into account the decision criteria such as, total reliability, maintenance cost and maintenance time. Depending on the life cycle duration, the desired availability, and the desired business model (sales or rental), this tool provides visibility of overall costs and optimal product architecture.

Keywords: availability, design for maintenance (DFM), dynamic maintenance, life cycle cost (LCC), maintenance free operating period (MFOP), simultaneous optimization

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Authors: D. De-León-Escobedo, D. J. Delgado-Hernández, S. Pérez

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A probabilistic formulation to assess the slopes safety under the hazard of strong storms is presented and illustrated through a slope in Mexico. The formulation is based on the classical safety factor (SF) used in practice to appraise the slope stability, but it is introduced the treatment of uncertainties, and the slope failure probability is calculated as the probability that SF<1. As the main hazard is the rainfall on the area, statistics of rainfall intensity and duration are considered and modeled with an exponential distribution. The expected life-cycle cost is assessed by considering a monetary value on the slope failure consequences. Alternative mitigation measures are simulated, and the formulation is used to get the measures driving to the optimal one (minimum life-cycle costs). For the example, the optimal mitigation measure is the reduction on the slope inclination angle.

Keywords: expected life-cycle cost, failure probability, slopes failure, storms

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Authors: Hagos Gebrehiwet Bahta

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Asmara, the capital city of Eritrea, is facing a sanitation challenge because the city discharges its wastewater to the environment without any kind of treatment. The aim of this research is to conduct a pre-feasibility study of using constructed wetlands in the peri-urban areas of Asmara for wastewater treatment and reuse. It was found that around 15,000 m³ of wastewater is used daily for agricultural activities, and products are sold in the city's markets, which are claimed to cause some health effects. In this study, three potential sites were investigated around Mai-Bela and an optimum location was selected on the basis of land availability, topography, and geotechnical information. Some types of local microphytes that can be used in constructed wetlands have been identified and documented for further studies. It was found that subsurface constructed wetlands can provide a sufficient pollutant removal with careful planning and design. Following the feasibility study, a preliminary design of screening, grit chamber and subsurface constructed wetland was prepared and cost estimation was done. In the cost estimation part, the filter media was found to be the most expensive part and consists of around 30% percent of the overall cost. The city wastewater drainage runs in two directions and the selected site is located in the southern sub-system, which only carries sewage (separate system). The wastewater analysis conducted particularly around this area (Sembel) indicates high heavy metal levels and organic concentrations, which reveals that there is a high level of industrial pollution in addition to the domestic sewage.

Keywords: agriculture, constructed wetland, Mai-Bela, wastewater reuse

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Authors: N. Jena, Nitin Seth

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Globalization and free trade has forced the organizations to continuously rethink and rework on the increasing cost of logistics. World wide, it is visualized that on one side the steel sector is witnessing rapid growth and on the other side it is facing huge challenges in terms of availability of raw materials for uninterrupted production. Inbound logistics also gains significant importance for ensuring the timely availability of raw materials. It is seen that in Indian steel sector logistic cost is still very large and challenging. Effectively managing the inbound logistics in steel decides the profitability and serviceability of the organization. Effective management of inbound logistics also has a major role on the inventory of the organization. Since, the logistics for the steel industry in India is evolving rapidly and it is the interplay of infrastructure, technology and new types of service providers that will define whether the industry is able to help its customers to reduce their logistics costs. Integration of Logistics has been treated as one of the most potential area for the companies to provide a base for cost reduction. In spite of the proven area for benefits for the industry, it is very surprising that none of the researchers have explored this area. Although, many researchers explored the subject of logistics in steel industry, but their perspective varied from exploring and understanding the associated cost and finding out the relations between them. Visualizing a potential gap, the present research is under taken to explore the integration opportunities in inbound logistics for steel sector. Typically in Indian steel sector where in most of the manufacturers depend on imported materials for processing the logistics is very challenging and accounts for transactions at supplier – who is situated in different country, shipper- who is transporting the material to the host country, regulators in both countries-that include customs and various clearing agents, local logistics service providers and local transporters/handlers. It is seen that In bound logistics cost in the steel sector is very high and accounts for about 15-16% of the turn over, integration of information across different channels provides and opportunity for improvements and growth of the organization. In the present paper, a case of leading steel manufacturer has been taken and the potentials for integration of information across various partners have been identified. The paper provides the identification of grey area in steel sector for major improvements in cycle time and lowering the inventories by integration of information. Finally, based on integration of information, the paper presents a business information framework for steel sector.

Keywords: integration, steel sectors, suppliers, shippers, customs and cargo agents, transporters

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Authors: Hsiao-Lin Fang

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The Patient Self-Determination Act is based on the belief that each life is unique. The act regards each patient as an autonomous entity and explicitly protects the patient’s rights to know and make decisions and choices while ensuring that the patient’s wish for a peaceful end is granted. Even when the patient is unconscious and unable to express himself/herself, the patient’s self-determination and its exercise are still protected under the law. The act also ensures that healthcare professionals (HCPs) have a specific set of rules to follow and complete legal protection when their patients are unable to express themselves clearly. This report is about a 55-year-old female patient who weighed 110 kg and was diagnosed with acute type A aortic dissection. The case was that the patient suddenly felt backache and nausea during sleep before daybreak and was therefore transferred to this hospital from the original one. After the doctor explained the patient’s conditions, it was concluded that surgery was necessary. However, the patient’s family was immediately against the surgery after having heard its possible complications. Nevertheless, the patient was still willing to receive the surgery. Being at odds with her family, the patient decided to sign the surgery agreement herself and agreed to receive the two surgical procedures: (1) ascending aorta replacement and (2) innominate artery debranching. After the surgery, the patient did not regain consciousness and therefore received computed tomography scanning of the brain, which revealed false lumen involving proximal left common carotid artery, left subclavian artery and innominate artery, and severe compression of the true lumen with total/subtotal occlusion in the left common carotid artery. On the following day, the doctor discussed two further surgical procedures: (1) endografting for descending aorta and (2) endografting for left common carotid artery and subclavian artery with the family. However, as the patient’s postoperative recovery of consciousness only reached the level of stupor and her family had no intention of subsequent healthcare for the patient, the family made the joint decision three days later to have the endotracheal tube removed from the patient and let her die a natural death. Suggestion: An advance directive (AD) can be created beforehand. Once the patient is in a special clinical state (e.g., terminal illness, permanent vegetative state, etc.), the AD can determine whether to sustain the patient’s life through ‘medical intervention’ or to respect the patient’s rights to choose a peaceful end and receive palliative care. Through the expression of self-determination, it is possible to respect the patient’s medical practice autonomy and protect the patient’s dignity and right to a peaceful end, thereby respecting and supporting the patient’s decision. This also allows the three sides: the patient, the family and the medical team to understand the patient’s true wish in the process of advance care planning (ACP) and thereby promote harmony in the HCP-patient relationship.

Keywords: intensive care unit patient, cardiovascular surgery, self-determination, advance directive

Procedia PDF Downloads 158

Authors: Jaemin Kim, Ilsun Pang, Yongrae Cho, Kwanghun Kim, Sungsun Baik

Abstract:

Manufacturing cost reduction is becoming more important due to excessive oversupply of Single crystalline ingot in recent solar market. Many companies are carrying out extensive research to grow more than one Single crystalline ingot in one batch to reduce manufacturing cost. However what most companies are finding difficult in this process is the effect on ingot due to increasing levels of impurities. Every ingot leaves a certain amount of melt after it is fully grown. This is the impurity that lowers the ingot quality. This impurity increase in the batch after second, third and more are grown subsequently in one batch. In order to solve this problem, the experiment to remove the residual melt in high temperature of hot zone was performed and succeeded. Theoretical average metal concentration of second ingot by new method was calculated and compared to it by conventional method.

Keywords: single crystal, solar cell, metal impurity, Ingot

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Authors: Leslie Beale

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Being a patient with a chronic disease is both a physical and emotional experience. The ability to recognize a patient’s emotional health is an important part of a health care provider’s skills. For the purposes of this paper, emotional health is viewed as the way that we feel, and the way that our feelings affect us. Understanding the patient’s emotional health leads to improved provider-patient relationships and health outcomes. For example, when a patient first hears his or her diagnosis from a provider, they might find it difficult to cope with their emotions. Struggling to cope with emotions interferes with the patient’s ability to read, understand, and act on health information and services. As a result, the patient becomes more frustrated and confused, creating barriers to accessing healthcare services. These barriers are challenging for both the patient and their healthcare providers. There are five basic emotions that are part of who we are and are always with us: fear, anger, sadness, joy, and compassion. Living with a chronic disease however can cause a patient to experience and express these emotions in new and unique ways. Within the provider-patient relationship, there needs to be an understanding that each patient experiences these five emotions and, experiences them at different times. In response to this need, the paper highlights a health promotion framework for patients with chronic disease. This framework emphasizes the emotional health of patients.

Keywords: health promotion, emotional health, patients with chronic disease, patient-centered care

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Authors: Arvind Kumar

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The city of Kanpur is located in the terrestrial plain area on the bank of the river Ganges and is the second largest city in the state of Uttar Pradesh. The city generates approximately 1400-1600 tons per day of MSW. Kanpur has been known as a major point and non-points-based pollution hotspot for the river Ganges. The city has a major industrial hub, probably the largest in the state, catering to the manufacturing and recycling of plastic and other dry waste streams. There are 4 to 5 major drains flowing across the city, which receive a significant quantity of waste leakage, which subsequently adds to the Ganges flow and is carried to the Bay of Bengal. A river-to-sea flow approach has been established to account for leaked waste into urban drains, leading to the build-up of marine litter. Throughout its journey, the river accumulates plastic – macro, meso, and micro, from various sources and transports it towards the sea. The Ganges network forms the second-largest plastic-polluting catchment in the world, with over 0.12 million tonnes of plastic discharged into marine ecosystems per year and is among 14 continental rivers into which over a quarter of global waste is discarded 3.150 Kilo tons of plastic waste is generated in Kanpur, out of which 10%-13% of plastic is leaked into the local drains and water flow systems. With the Support of Kanpur Municipal Corporation, 1TPD capacity MRF for drain waste management was established at Krishna Nagar, Kanpur & A German startup- Plastic Fisher, was identified for providing a solution to capture the drain waste and achieve its recycling in a sustainable manner with a circular economy approach. The team at Plastic Fisher conducted joint surveys and identified locations on 3 drains at Kanpur using GIS maps developed during the survey. It suggested putting floating 'Boom Barriers' across the drains with a low-cost material, which reduced their cost to only 2000 INR per barrier. The project was built upon the self-sustaining financial model. The project includes activities where a cost-efficient model is developed and adopted for a socially self-inclusive model. The project has recommended the use of low-cost floating boom barriers for capturing waste from drains. This involves a one-time time cost and has no operational cost. Manpower is engaged in fishing and capturing immobilized waste, whose salaries are paid by the Plastic Fisher. The captured material is sun-dried and transported to the designated place, where the shed and power connection, which act as MRF, are provided by the city Municipal corporation. Material aggregation, baling, and transportation costs to end-users are borne by Plastic Fisher as well.

Keywords: Kanpur, marine environment, drain waste management, plastic fisher

Procedia PDF Downloads 49

Authors: Michael Ricardo Lang, AdriéLle Costa, Ivana Iesbik, Karine Haag, Leonardo Trindade Buffara, Oscar Reimann Junior, Chelin Auswaldt Steclan

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Stroke affects not only the individual, but has significant impacts on the social and family context. Therefore, it is necessary to know the peculiarities of each region, in order to contribute to regional public health policies effectively. Thus, the present study discusses biomarkers in a post-stroke population, admitted to a stroke unit (U-stroke) of reference in the southern region of Brazil. Biomarkers were analyzed, such as age, length of stay, mortality rate, survival time, risk factors and family history of stroke in patients after ischemic stroke. In this studied population, comparing men and women, it was identified that men were more affected than women, and the average age of women affected was higher, as they also had the highest mortality rate and the shortest hospital stay. The risk factors identified here were according to the global scenario; with SAH being the most frequent and those associated with sedentary lifestyle in women the most frequent (dyspilipidemia, heart disease and obesity). In view of this, the importance of studies that characterize populations regionally is evident, strengthening the strategic planning of policies in favor of health care.

Keywords: biomarkers, sex, stroke, stroke unit, population

Procedia PDF Downloads 245

Authors: Nuran Bahar, Mehmet A. Akcayol

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In the aviation industry, many faults may occur frequently during the maintenance processes and assembly operations of complex structured aircrafts because of their high dependencies of components. These faults affect the quality of aircraft parts or developed modules adversely. Technical employee requires long time and high labor force while checking the correctness of each component. In addition, the person must be trained regularly because of the ever-growing and changing technology. Generally, the cost of this training is very high. Augmented Reality (AR) technology reduces the cost of training radically and improves the effectiveness of the training. In this study, the usage of AR technology in the aviation industry has been investigated and the effectiveness of AR with heads-up display glasses has been examined. An application has been developed for comparison of production process with AR and manual one.

Keywords: aerospace, assembly quality, augmented reality, heads-up display

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Authors: Denisa Mackova, Andrea Pokorna

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The management of postoperative pain is a meaningful part of quality care. The experience and knowledge of registered nurses in postoperative pain management can be influenced by local know-how. Therefore, the research helps to understand the cultural differences between two countries with the aim of evaluating the management of postoperative pain management among the nurses from the Czech Republic and the Kingdom of Saudi Arabia. Both countries have different procedures on managing postoperative pain and the research will provide an understanding of both the advantages and disadvantages of the procedures and also highlight the knowledge and experience of registered nurses in both countries. Between the Czech Republic and the Kingdom of Saudi Arabia, the expectation is for differing results in the usage of opioid analgesia for the patients postoperatively and in the experience of registered nurses with Patient Controlled Analgesia. The aim is to evaluate the knowledge and awareness of registered nurses and to merge the data with the postoperative pain management in the early postoperative period in the Czech Republic and the Kingdom of Saudi Arabia. Also, the aim is to assess the knowledge and experience of registered nurses by using Patient Controlled Analgesia and epidural analgesia treatment in the early postoperative period. The criteria for those providing input into the study, are registered nurses, working in surgical settings (standard departments, post-anesthesia care unit, day care surgery or ICU’s) caring for patients in the postoperative period. Method: Research is being conducted by questionnaires. It is a quantitative research, a comparative study of registered nurses in the Czech Republic and the Kingdom of Saudi Arabia. Questionnaire surveys were distributed through an electronic Bristol online survey. Results: The collection of the data in the Kingdom of Saudi Arabia has been completed successfully, with 550 respondents, 77 were excluded and 473 respondents were included for statistical data analysis. The outcome of the research is expected to highlight the differences in treatment through Patient Controlled Analgesia, with more frequent use in the Kingdom of Saudi Arabia. A similar assumption is expected for treatment conducted by analgesia. We predict that opioids will be used more regularly in the Kingdom of Saudi Arabia, whilst therapy through NSAID’s being the most common approach in the Czech Republic. Discussion/Conclusion: The majority of respondents from the Kingdom of Saudi Arabia were female registered nurses from a multitude of nations. We are expecting a similar split in gender between the Czech Republic respondents; however, there will be a smaller number of nationalities. Relevance for research and practice: Output from the research will assess the knowledge, experience and practice of patient controlled analgesia and epidural analgesia treatment. Acknowledgement: This research was accepted and affiliated to the project: Postoperative pain management, knowledge and experience registered nurses (Czech Republic and Kingdom of Saudi Arabia) – SGS05/2019-2020.

Keywords: acute postoperative pain, epidural analgesia, nursing care, patient controlled analgesia

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Authors: Victor Siahaan

Abstract:

Coal still become the most important energy source for electricity generation known for its contribution which take the biggest portion of energy mix that a country has, for example Indonesia. The low cost of electricity generation and quite a lot of resources make this energy still be the first choice to fill the portion of base load power. To realize its significance to produce electricity, it is necessary to know the amount of coal (volume) needed to ensure that all coal power plants (CPP) in a country can operate properly. To secure the volume of coal, in this study, discussion was carried out regarding the identification of coal mining sources in Indonesia, classification of coal typical from each coal mining sources, and determination of the port of loading. By using data above, the sources of coal mining are then selected to feed certain CPP based on the compatibility of the coal typical and the lowest transport cost.

Keywords: merit order, Indonesian coal mine, electricity, power plant

Procedia PDF Downloads 138

Authors: Fouzia Brihmat

Abstract:

Economic planning models, which are used to build microgrids and distributed energy resources, are the current norm for expressing such confidence (DER). These models often decide both short-term DER dispatch and long-term DER investments. This research investigates the most cost-effective hybrid (photovoltaic-diesel) renewable energy system (HRES) based on Total Net Present Cost (TNPC) in an Algerian Saharan area, which has a high potential for solar irradiation and has a production capacity of 1GW/h. Lead-acid batteries have been around much longer and are easier to understand, but have limited storage capacity. Lithium-ion batteries last longer, are lighter, but generally more expensive. By combining the advantages of each chemistry, we produce cost-effective high-capacity battery banks that operate solely on AC coupling. The financial implications of this research describe the corrosion process that occurs at the interface between the active material and grid material of the positive plate of a lead-acid battery. The best cost study for the HRES is completed with the assistance of the HOMER Pro MATLAB Link. Additionally, during the course of the project's 20 years, the system is simulated for each time step. In this model, which takes into consideration decline in solar efficiency, changes in battery storage levels over time, and rises in fuel prices above the rate of inflation. The trade-off is that the model is more accurate, but it took longer to compute. As a consequence, the model is more precise, but the computation takes longer. We initially utilized the Optimizer to run the model without MultiYear in order to discover the best system architecture. The optimal system for the single-year scenario is the Danvest generator, which has 760 kW, 200 kWh of the necessary quantity of lead-acid storage, and a somewhat lower COE of $0.309/kWh. Different scenarios that account for fluctuations in the gasified biomass generator's production of electricity have been simulated, and various strategies to guarantee the balance between generation and consumption have been investigated. The technological optimization of the same system has been finished and is being reviewed in a recent paper study.

Keywords: battery, corrosion, diesel, economic planning optimization, hybrid energy system, lead-acid battery, multi-year planning, microgrid, price forecast, PV, total net present cost

Procedia PDF Downloads 74

Authors: Magno Enrique Mendoza Meza

Abstract:

This paper deals with the comparison of three control techniques: the hysteresis on-off control (HyOOC), the hybrid on-off control (HOOC) and the simple Structured Treatment Interruptions (sSTI). These techniques are applied to the mathematical model developed by Kirschner and Webb. To compare these techniques we use a cost functional that minimize the wild-type virus population and the mutant virus population, but the main objective is to minimize the systemic cost of treatment and maximize levels of healthy CD4+ T cells. HyOOC, HOOC, and sSTI are applied to the drug therapies using a reverse transcriptase and protease inhibitors; simulations show that these controls maintain the uninfected cells in a small, bounded neighborhood of a pre-specified level. The controller HyOOC and HOOC are designed by appropriate choice of virtual equilibrium points.

Keywords: virus dynamics, on-off control, hysteresis, multi-drug therapies

Procedia PDF Downloads 382